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Management of the Mangled Hand and Forearm

Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Ky.

In this article the authors describe the methods and procedures that have been used to help patients regain hand and forearm function after mangling injuries. Assessment of the pathophysiologic condition, careful inventory of the injured structures, and early aggressive wound excision and reconstruction, followed by expert rehabilitation, are advocated. The importance of vascular restoration, stable skeletal fixation, and provision of adequate skin cover are stressed. In addition to describing their treatment approach, the authors emphasize the need for the surgeon to be well acquainted with each phase of the treatment process.